AB1366 ULTRASOUND ASSESSMENT OF THE EFFECTIVENESS OF TOCILIZUMAB IN GIANT CELL ARTERITIS. STUDY OF 26 PATIENTS FROM CLINICAL PRACTICE
Authors: J. Sanchez-Martin, J. Loricera, L. Sanchez-Bilbao, E. De Miguel, R. Melero, E. Galíndez-Agirregoikoa, J. Narváez, C. Galisteo, J. C. Nieto González, P. Moya, E. Labrador-Sánchez, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2022)

Background Large-vessel vasculitis are characterized by the wall inflammation of the involved vessels, which can be detected by imaging tools (1-3 ). Ultrasound (US) is one of the most commonly used tools for the diagnosis of giant cell arteritis (GCA), especially in patients with a cranial phenotype. Tocilizumab (TCZ) has shown efficacy in large-vessel vasculitis (LVV) including GCA (4,5 ). However, the improvement objectified by imaging techniques such as US after TCZ therapy is poorly documented. Objectives To assess the effectiveness of TCZ improving the wall vessel inflammation by US. Methods Observational, multicenter study of 26 GCA patients treated with TCZ. GCA was diagnosed according to: a ) ACR criteria, and/or b ) biopsy of temporal artery, and/or c ) presence of signs of vessel wall inflammation by US, defined by the presence of halo sign. In all the cases a baseline US and in the follow-up was mandatory. Patients were divided into two subgroups: a ) with, and b ) without signs of improvement (partial or total) in the follow-up US. Results We studied 26 patients (19 women/7 men; mean age, 76.3±9.7 years). Main clinical features of GCA with and without US improvement are shown in Table 1. We found no significant differences in any of the variables studied between the two groups. Table 1. Main features of 27 GCA patients treated with tocilizumab followed by Ultrasound (US). With US improvement (n=21 ) Without US improvement (n=5 ) p Baseline characteristics at TCZ onset General characteristics Age(years), mean±SD 77.3±8.9 72.2±12.9 0.270 Sex, female/male (% female) 17/4 (80,95) 2/3 (40) 0.101 Time from GCA diagnosis to TCZ onset (months), median [IQR] 6 [3-9] 3 [1-6] 0.452 Systemic manifestations, n (% ) Fever, n (%) 1/21 (4.76) 1/5 (20) 0.354 Constitutional syndrome, n (%) 10/21 (47.62) 2/5 (40) 0.999 PmR, n (%) 11/21 (52.38) 1/5 (20) 0.330 Ischaemic manifestations, n (% ) Visual involvement, n (%) 1/21 (4.76) 1/5 (20) 0.354 Headache, n (%) 15/21 (71.43) 5/5 (100) 0.298 Jaw claudication, n (%) 4/15 (26.67) ¼ (25) 0.999 Laboratory data ESR, mm 1st hour, median [IQR] 33 [22-49] 55 [54-80] 0.216 CRP, mg/dL, median [IQR] 1.5 [0.7-6.7] 3.8 [1-4.2] 0.948 Prednisone dose, mg/day, median [IQR] 13.7 [10-30] 30 [12.5-30] 0.505 Time from TCZ onset and follow-up US (months) 3.9±3.6 3.1±2.1 0.456 After TCZ onset, 21 of 26 patients (80.7%) showed US signs of improvement (12 complete, 9 partial). In 4 out of 5 patients in whom there was no improvement in US findings, clinical improvement was observed at first month after starting TCZ. Conclusion TCZ seems to be effective controlling GCA including vascular involvement detected by US. This improvement can be seen by follow-up US, especially when performed at least 3 months after TCZ onset. References [1]Loricera J, et al. Rev Esp Med Nucl Imagen Mol. 2015; 34: 372-7. PMID: 26272121 [2]Loricera J, et al. Clin Exp Rheumatol. 2015; 33: S19-31. PMID: 25437450 [3]Prieto-Peña D, et al. Ther Adv Musculoskelet Dis. 2021; 13: 1759720X211020917. PMID: 34211589 [4]Martínez-Rodríguez I, et al. Semin Arthritis Rheum. 2018; 47: 530-537. PMID: 28967430 [5]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019; 48: 720-727. PMID: 29903537 Acknowledgements Tocilizumab in Giant Cell Arteritis Spanish Collaborative Group: Juan C. González Nieto (H. Gregorio Marañón), Juan R. de Dios (H.U. Araba), Esther Fernández (H. Clínico Universitario Virgen de la Arrixaca), Isabel de la Morena (H. Clínico Universitario de Valencia), Patricia Moya (H. Sant Pau), Roser Solans i Laqué (H. Valle de Hebrón), Eva Pérez Pampín (H.U. de Santiago), José L. Andréu (H.U. Puerta de Hierro), Marcelino Revenga (H. Ramón y Cajal), Juan P. Baldivieso Achá (H. U. de La Princesa), Eztizen Labrador (H. San Pedro), Andrea García-Valle (Complejo Asistencial Universitario de Palencia), Adela Gallego (Complejo Hospitalario Universitario de Badajoz), Carlota Iñíguez (H.U. Lucus Augusti), Cristina Hidalgo (Complejo Asistencial Universitario de Salamanca), Noemí Garrido-Puñal (H. Virgen del Rocío), Ruth López-González (Complejo Hospitalario de Zamora), José A. Román-Ivorra (H.U. y Politécnico La Fe), Sara Manrique (H. Regional de Málaga), Paz Collado (H.U. Severo Ochoa), Enrique Raya (H. San Cecilio), Valvanera Pinillos (H. San Pedro), Francisco Navarro (H. General Universitario de Elche), Alejandro Olivé-Marqués (H. Trías i Pujol), Francisco J. Toyos (H.U. Virgen Macarena), María L. Marena Rojas (H. La Mancha Centro), Antoni Juan Más (H.U. Son Llàtzer), Beatriz Arca (H.U. San Agustín), Carmen Ordás-Calvo (H. Cabueñes), María D. Boquet (H. Arnau de Vilanova), Noelia Álvarez-Rivas (H.U. Lucus Augusti), María L. Velloso-Feijoo (H.U. de Valme), Cristina Campos (H. General Universitario de Valencia), Íñigo Rúa-Figueroa (H. Doctor Negrín), Antonio García (H. Virgen de las Nieves), Carlos Vázquez (H. Miguel Servet), Pau Lluch (H. Mateu Orfila), Carmen Torres (Complejo Asistencial de Ávila), Cristina Luna (H.U. Nuestra Señora de la Candelaria), Elena Becerra (H.U. de Torrevieja), Nagore Fernández-Llanio (H. Arnáu de Vilanova), Arantxa Conesa (H.U. de Castellón), Eva Salgado (Complejo Hospitalario Universitario de Ourense). Disclosure of Interests Julio Sanchez-Martin: None declared, Javier Loricera: None declared, Lara Sanchez-Bilbao: None declared, Eugenio de Miguel: None declared, Rafael Melero: None declared, E. Galíndez-Agirregoikoa: None declared, J. Narváez: None declared, Carles Galisteo: None declared, Juan Carlos Nieto González: None declared, Patricia Moya: None declared, Eztizen Labrador-Sánchez: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Grant/research support from: Abbvie, MSD and Roche